Apparatus and method for orthopedic fixation

ABSTRACT

A filament retaining washer for mounting about the shank of a bone screw deployed in a bone whereby to retain the filament to the bone, the filament retaining washer comprising a structure having a screw hole extending therethrough for receiving therein the shank of the bone screw deployed in the bone, whereby to secure the structure to the bone, the screw hole defining a first axis, and the structure having a filament hole extending therethrough for receiving a filament therein so as to retain the filament to the structure, the filament hole defining a second axis extending substantially perpendicular to the first axis.

REFERENCE TO PENDING PRIOR PATENT APPLICATION

This application is a continuation-in-part of pending U.S. patentapplication Ser. No. 09/863,174, filed May 23, 2001 by T. Wade Fallin etal. for APPARATUS AND METHOD FOR ORTHOPEDIC FIXATION (Attorney's DocketNo. MED-8), which patent application is hereby incorporated herein byreference.

FIELD OF THE INVENTION

This invention relates to surgical apparatus and methods in general, andmore particularly to surgical apparatus and methods for fixing bone andsoft tissue in place during trauma and reconstructive surgery.

BACKGROUND OF THE INVENTION

Bone fixation, sometimes also referred to as fracture fixation, is anestablished art. Fixation screws, and fixation screws in combinationwith metal plates, are widely used in the art to stabilize bone so as tofacilitate healing.

Surgical cables, and surgical cables in combination with metal plates,are also well known in the bone fixation art. Cables, and cables incombination with plates, are generally used in situations where the useof screws, or screws in combination with plates, is not suitable. By wayof example, cables, and cables in combination with plates, arefrequently used in the fixation of long oblique fractures resulting fromhigh energy trauma such as a motor vehicle accident. By way of furtherexample, screw fixation is frequently not adequate for fractures thatare highly comminuted, and fixation with cables, or cables incombination with plates, is required.

Cables are also sometimes used in conjunction with screws, and inconjunction with screws in combination with plates. By way of example,cables may be used in conjunction with screws, and screws in combinationwith plates, where a screw strips its threads in deployment, or wherescrews, or screws in combination with plates, are deemed insufficientfor the fixation at hand.

With cable fixation, it is customary to encircle the subject bone withthe body of the cable, and then to secure the two free ends of the cabletogether with a deformable crimp so as to effect fixation.

In general, cable fixation on the shaft of a so-called “long bone” doesnot present a significant problem with migration, inasmuch as thisportion of the bone is substantially tubular in geometry. However, theends of these long bones typically have a significant flare in theirgeometry. As a result, tightening of the encircling cable often causesthe cable (and crimp) to migrate toward the narrower section of thebone. Such migration can displace the cable sufficiently far from itsintended location as to significantly loosen, or render ineffective,encirclement of the bone segments.

Thus, there is a need for an improved apparatus and method which willpermit bone fixation to be effected with screws and cable.

There further exists a need for an improved apparatus and method foreffecting bone fixation with cable, such that the cable will not slidealong the bone during tightening of the cable.

In addition to the foregoing, in many situations, soft tissue may needto be attached to bone. By way of example, a ligament may need to beattached to bone during trauma and reconstructive surgery. In some ofthese situations, bone fixation may also be necessary, and such bonefixation may involve the use of screws, and/or cables and plates, eitheralone or in combination with one another.

Thus, there is a need for an improved apparatus and method for attachingsoft tissue to bone.

There further exists a need for an improved apparatus and method forattaching soft tissue to bone, where screws may be used to help effectfixation to bone.

SUMMARY OF THE INVENTION

Accordingly, one object of the present invention is to provide improvedapparatus for use in bone fixation.

Another object of the present invention is to provide improved apparatusfor use in bone fixation which involves the use of bone screws, metalplates and/or cables.

Still another object of the present invention is to provide an improvedmethod for bone fixation.

Yet another object of the present invention is to provide improvedapparatus for attaching soft tissue to bone.

And another object of the present invention is to provide improvedapparatus for attaching soft tissue to bone, where screws may be used tohelp effect fixation to bone.

A further object of the present invention is to provide an improvedmethod for attaching soft tissue to bone.

These and other objects of the present invention are addressed by theprovision and use of a novel filament retaining washer for mountingabout the shank of a bone screw deployed in a bone whereby to retain thefilament to the bone, the filament retaining washer comprising astructure having a screw hole extending therethrough for receivingtherein the shank of the bone screw deployed in the bone, whereby tosecure the structure to the bone, the screw hole defining a first axis,and the structure having a filament hole extending therethrough forreceiving a filament therein so as to retain the filament to thestructure, the filament hole defining a second axis extendingsubstantially perpendicular to the first axis, with the second axisbeing aligned with a bone screw extending through the screw hole.

In another form of the invention, there is provided a filament retainingwasher for mounting about the shank of a bone screw deployed in a bonewhereby to retain the filament to the bone, the filament retainingwasher comprising a body; a downwardly projecting extension connected tothe body and having a screw hole extending therethrough for receivingtherein the shank of the bone screw deployed in the bone, whereby tosecure the downwardly projecting extension to the bone, the screw holedefining a first axis; and an upwardly projecting extension connected tothe body and having a filament hole extending therethrough for receivinga filament therein so as to retain the filament to the upwardlyprojecting extension, the filament hole defining a second axis extendingsubstantially perpendicular to the first axis, with the second axisbeing aligned with a bone screw extending through the screw hole.

And in another form of the invention, there is provided a system forsecuring an object to a bone, the system comprising a bone screw; awasher comprising a body, a downwardly projecting extension connected tothe body and having a screw hole extending therethrough for receivingtherein the shank of the bone screw deployed in the bone, whereby tosecure the downwardly projecting extension to the bone, the screw holedefining a first axis, and an upwardly projecting extension connected tothe body and having a filament hole extending therethrough, forreceiving a filament therein so as to retain the filament to theupwardly projecting extension, the filament hole defining a second axisextending substantially perpendicular to the first, axis, with thesecond axis being aligned with a bone screw extending through the screwhole; and a filament received by the filament hole, the filamentsecuring the object to the bone.

In another form of the invention, there is provided a method forsecuring an object to a bone, the method comprising providing a screw, afilament and a suture retaining washer, the suture retaining washercomprising a body, a downwardly projecting extension connected to thebody and having a screw hole extending therethrough for receivingtherein the shank of a bone screw deployed in the bone, whereby tosecure the downwardly projecting extension to the bone, the screw holedefining a first axis, and an upwardly projecting extension connected tothe body and having a filament hole extending therethrough for receivinga filament therein so as to retain the filament to the upwardlyprojecting extension, the filament hole defining a second axis extendingsubstantially perpendicular to the first axis, with the second axisbeing aligned with a bone screw extending through the screw hole;securing the washer to the bone with the screw, with the filamentextending through the filament hole; and using the filament to securethe object to the bone.

And in another form of the invention, there is provided a method forsecuring an object to a bone, the method comprising providing a screw, afilament and a suture retaining washer, the suture retaining washercomprising a structure having a screw hole extending therethrough forreceiving therein the shank of the bone screw deployed in the bone,whereby to secure the structure to the bone, the screw hole defining afirst axis, and the structure having a filament hole extendingtherethrough for receiving a filament therein so as to retain thefilament to the structure, the filament hole defining a second axisextending substantially perpendicular to the first axis, with the secondaxis being aligned with a bone screw extending through the screw hole;securing the washer to the bone with the screw, with the filamentextending through the filament hole; and using the filament to securethe object to the bone.

In another form of the invention, there is provided a filament retainingwasher for mounting about the shank of a bone screw deployed in a bonewhereby to retain the filament to the bone, the filament retainingwasher comprising: a body; a downwardly projecting extension connectedto the body and having a screw hole extending therethrough for receivingtherein the shank of the bone screw deployed in the bone, whereby tosecure the downwardly projecting extension to the bone, the screw holedefining a first axis; and an upwardly projecting extension connected tothe body and having a filament hole extending therethrough for receivinga filament therein so as to retain the filament to said upwardlyprojecting extension, the filament hole defining a second axis extendingsubstantially perpendicular to the first axis, with the upwardlyprojecting extension being displaced laterally and longitudinally fromthe downwardly projecting extension.

In another form of the invention, there is provided a filament retainingwasher for mounting about the shank of a bone screw deployed in a bonewhereby to retain the filament to the bone, the filament retainingwasher comprising: a structure having a screw hole extendingtherethrough for receiving therein the shank of the bone screw deployedin the bone, whereby to secure the structure to said bone, the screwhole defining a first axis, and the structure having a filament hole soas to retain the filament to the structure, the filament hole defining asecond axis extending substantially perpendicular to the first axis,with the second axis extending parallel to a third axis extendingthrough the first axis.

The above and other features of the invention, including various noveldetails of construction and combinations of parts, will now be moreparticularly described with reference to the accompanying drawings andpointed out in the claims. It will be understood that the particulardevices, assembly and method embodying the invention are shown by way ofillustration only and not as limitations of the invention. Theprinciples and features of this invention may be employed in various andnumerous embodiments without departing from the scope of the invention.

BRIEF DESCRIPTION OF THE DRAWINGS

These and other objects and features of the present invention will bemore fully disclosed or rendered obvious by the following detaileddescription of the preferred embodiments of the invention, which is tobe considered together with the accompanying drawings wherein likenumbers refer to like parts, and further wherein:

FIG. 1 is a perspective view showing a novel surgical fastening systemsecuring together two bone segments;

FIG. 2 is perspective view of a cable retaining washer which forms partof the surgical fastening system shown in FIG. 1;

FIG. 3 is an exploded side view, in section, of a bone screw, cableretaining washer and bone plate which form part of the surgicalfastening system shown in FIG. 1;

FIG. 4 is a perspective view of an alternate form of cable retainingwasher formed in accordance with the present invention;

FIG. 5 is a perspective view of another alternative form of cableretaining washer formed in accordance with the present invention;

FIG. 6 is a perspective view of still another alternative form of cableretaining washer formed in accordance with the present invention;

FIG. 7 is a perspective view of yet another alternative form of cableretaining washer formed in accordance with the present invention;

FIG. 8 is a perspective view of a bone screw, cable retaining washer andbone plate which comprise another embodiment of the present invention;

FIG. 9 is a side view, in section, of the apparatus shown in FIG. 8;

FIG. 10 is a side view, partially in section, showing a bone screwsecuring the cable retaining washer of FIG. 2 directly to a bone;

FIG. 11 is a perspective view showing an alternative form of surgicalfastening system formed in accordance with the present invention;

FIG. 12 is a perspective view of a suture retaining washer which formspart of the surgical fastening system shown in FIG. 11;

FIG. 13 is a partial sectional view of a bone screw and suture retainingwasher which form part of the surgical fastening system shown in FIG.11;

FIG. 14 is a perspective view showing a suture loop attaching a piece ofsurgical mesh to a suture retaining washer;

FIG. 15 is a view similar to that of FIG. 11, except showing theassembly of FIG. 14 secured to a bone;

FIGS. 18-16 are schematic views showing another alternative form ofcable retaining washer;

FIG. 19 is a schematic view showing another alternative form of cableretaining washer;

FIG. 20 is a schematic view showing still another alternative form ofcable retaining washer;

FIG. 21 is a schematic view of yet another form of cable retainingwasher;

FIG. 22 is a schematic view of another form of cable retaining washer;

FIG. 23 is a schematic view of another form of cable retaining washer;and

FIG. 24-26 are schematic views showing an alternative form of sutureretaining washer.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

Looking first at FIGS. 1-3, there is shown a surgical fastening system 5which comprises one preferred form of the invention.

Surgical fastening system 5 generally comprises a bone plate 6, aplurality of bone screws 9, a plurality of cable retaining washers 12,and a plurality of cable loops 15. As used herein, the term “cable” isintended to encompass braided cable, wire and the like.

Bone plate 6 is deployed so that the bone plate extends across thefracture line 18 of two bone segments 20, 21. The heads 25 (FIG. 3) ofbone screws 9 engage cable retaining washers 12, while the shanks 27 ofbone screws 9 extend through screw holes 30 in cable retaining washers12, through screw holes 33 in bone plate 6 and into bone segments 20,21, whereby to secure bone plate 6 to bone segments 20, 21 and, the inprocess, to secure bone segments 20, 21 together. Additionally, cableloops 15 encircle bone segments 20, 21 and are secured to cableretaining washers 12, whereby cable loops 15 further secure bonesegments 20, 21 to bone plate 6 and, as a result, to one another.

Bone plate 6 is of the sort well known in the art. By way of example butnot limitation, bone plate 6 generally comprises an elongated body 35penetrated by the aforementioned screw holes 33. The bone plate's topsurface 36 generally includes recesses 40 about the top ends of screwholes 33; in conventional bone plate applications, recesses 40 receivethe semi-spherical undersides of the heads 25 of bone screws 9.

Bone screws 9 are also of the sort well known in the art. Bone screws 9comprise the aforementioned head 25 and the aforementioned shank 27.

Cable restraining washer 12 comprises a body 45 having a bottom surface48 (FIG. 3) for engaging the top surface 36 of bone plate 6, adownwardly projecting extension 50 for seating in a recess 40 in boneplate 6, and an upwardly projecting extension 55 for receiving andrestraining at least one cable loop 15.

Downwardly projecting extension 50 preferably has a semi-sphericalconfiguration similar to the semi-spherical underside of a head 25 of abone screw 9 so as to seat in one of the recesses 40 commonly formed inbone plate 6.

A recess 60 is formed in body 45, in alignment with the downwardlyprojecting extension 50 and screw hole 30. Recess 60 is sized so as toreceive the head 25 of a bone screw 9, and screw hole 30 is sized so asto receive the shank 27 of a bone screw 9. In this way, cablerestraining washer 12 can be mounted to bone plate 6 so that thewasher's downwardly projecting extension 50 seats in a recess 40 formedin bone plate 6, and a bone screw 9 may be passed through the cableretaining washer 12 so that the head 25 of the screw 9 is seated in thewasher's recess 60 and so that the shank 27 of the bone screw 9 passesthrough the washer's screw hole 30, through the screw hole 33 formed inbone plate 6, and into a bone segment 20, 21, whereby to secure thecable retaining washer 12 and bone plate 6 to one another, and to a bonesegment 20, 21.

Cable retaining washer 12 also comprises the upwardly projectingextension 55 for receiving and retaining one or more cable loops 15.More particularly, cable retaining washer 12 also comprises at least onecable hole 65 extending perpendicular to the axis of the washer's screwhole 30. Cable hole 65 is sized to slidingly receive a cable loop 15. Athreaded set screw hole 67 extends downwardly from the top surface 70 ofthe washer's upwardly projecting extension 55. The bottom end of setscrew hole 67 intersects the at least one cable hole 65 (FIG. 3). A setscrew 73 is positioned in set screw hole 67. Set screw 73 may betightened down so as to engage a cable loop 15 extending through a cablehole 65, whereby to secure that cable loop to the cable retaining washer12 and, as a result, to secure that cable loop to a bone segment 20, 21.

Surgical fastening system 5 is intended to be used as follows.

First, bone plate 6 is positioned against bone segments 20, 21. Thenbone screws 9 are used to secure cable retaining washers 12 and boneplate 6 to one another and to bone segments 20, 21. Next, cable loops 15are passed through cable holes 65 in the cable retaining washers 12, andthen set screws 73 are used to lock cable loops 15 to the washers.

Looking next at FIG. 4, there is shown a cable retaining washer 112which comprises an alternative form of the invention. Cable retainingwasher 112 is substantially the same as the cable retaining washer 12described above, except that it also includes a second upwardlyprojecting extension 55, along with that extension's associated cableholes(s) 65, set screw hole 67, and set screw 73.

Looking next at FIG. 5, there is shown a cable retaining washer 212which comprises another alternative form of the invention. Cableretaining washer 212 is substantially the same as the cable retainingwasher 12 described above, except that its upwardly projecting extension255 lacks the set screw hole 67 and set screw 73 for locking a cableloop 15 within a cable hole 65. Instead, with cable retaining washer212, upwardly projecting extension 255 is formed so as to be crimpable,whereby to mechanically lock a cable loop 15 within a cable hole 65. Inone preferred form of the invention, upwardly projecting extension 255is formed with a trapezoidal cross-section such as that shown in FIG. 5,whereby to facilitate crimping of the upwardly extending projection 255about the cable.

Looking next at FIG. 6, there is shown a cable retaining washer 312which comprises another alternative form of the invention. Cableretaining washer 312 is substantially the same as the cable retainingwasher 212 described above, except that it includes a second upwardlyprojecting extension 255.

Looking next at FIG. 7, there is shown a cable retaining washer 412which comprises another alternative form of the invention. Cableretaining washer 412 is substantially the same as the cable retainingwasher 312 described above, except that each of the upwardly projectingextensions 255 has only one cable hole 65 formed therein.

In the cable retaining washers 12, 112, 212, 312 and 412 describedabove, the downwardly projecting extension 55 has a semi-sphericalconfiguration so as essentially replicate the semi-spherical undersideof the head 25 of a bone screw 9, whereby it may be received in therecess 40 formed in bone plate 6. However, forming the downwardlyprojecting extension 55 with a semi-spherical configuration cansometimes result in the cable retaining washer turning somewhat aboutthe axis of its screw hole 30 as bone screw 9 is screwed into a bonesegment 20, 21. This can present an inconvenience to the surgeon.

To guard against this, and looking now at FIGS. 8 and 9, there is showna bone plate 506 which is provided with an elongated recess 540 and acable retaining washer 512. Cable retaining washer 512 is substantiallythe same as the cable retaining washer 212 shown in FIG. 5, except thatthe downwardly projecting extension 50 of cable retaining washer 212(FIG. 5) has been replaced with a downwardly projecting extension 550having a cross-sectional profile matching that of the bone plate'selongated recess 540. If desired, the cable retaining washers 12, 112,312, and 412 may also have their downwardly projecting extensions 50replaced with similar downwardly projecting extensions 550, whereby theycan mate securely with recesses 540 of a bone plate 506.

It is also possible to use the cable retaining washers of the presentinvention without a bone plate. In this case, the bone screw passesthrough the cable retaining washer and directly into a bone segment 20,21. If desired, cable retaining washers 12, 112, 212, 312, 412 and/or512 may be used in this way, with the downwardly projecting extensionsbearing against, and generally penetrating into, bone segment 20, 21.See, for example, FIG. 10, where cable retaining washer 12 is shownengaging a bone segment 20, 21.

Alternatively, if desired, the bottom surface of the cable retainingwasher can be modified so as to reduce, or entirely remove, thedownwardly projecting extension.

Looking next at FIGS. 11-13, there is shown a suture retaining washer612 which comprises another form of the invention. Suture retainingwasher 612 comprises a body 645. Suture retaining washer 612 alsocomprises a downwardly projecting extension 650 for seating in a recess40 of a bone plate 6 or for engaging the outer surface of a bone segment20, 21. Suture retaining washer 612 also comprises at least one upwardlyprojecting extension 655 for receiving and retaining at least one sutureloop 615.

A screw hole 30 is formed in downwardly projecting extension 650 and arecess 60 is formed in body 645. Recess 60 is sized to receive the head25 of a bone screw 9, and screw hole 30 is sized to receive the shank 27of bone screw 9. In this way, suture retaining washer 612 can be mountedto bone plate 6 so that the downwardly projecting extension 650 seats ina corresponding recess 40 in bone plate 6, and a bone screw 9 may bepassed through the suture retaining washer 612 so that the head 25 ofthe screw 9 is seated in the washer's recess 60 and the shank 27 of thebone screw 9 passes through the washer's screw hole 30, through thescrew hole 33 in bone plate 6, and into a bone segment 20, 21, wherebyto secure suture retaining washer 612 and bone plate 6 to one another,and to a bone segment 20, 21. Alternatively, suture retaining washer 612can be mounted directly to a bone segment 20, 21 by seating downwardlyprojecting extension 650 against a bone segment 20, 21, and then passinga bone screw 9 through the suture retaining washer 612 so that the head25 of the screw 9 is seated in the washer's recess 60 and the shank 27of the bone screw 9 passes through the washer's screw hole 30 and into abone segment 20, 21.

Suture retaining washer 612 also comprises at least one upwardlyprojecting extension 655 for receiving and retaining one or more loops615. More particularly, suture retaining washer 612 also comprises atleast one upwardly projecting extension 655, with each upwardlyprojecting extension having at least one suture hole 65 extendingperpendicular to the axis of the washer's screw hole 30. Suture hole 65is sized to slidingly receive a suture loop 615.

If desired, suture loops 615 can be used to secure soft tissue to bonesegments 20, 21. Alternatively, and looking next at FIGS. 14 and 15,suture loops 615 can be used to attach a surgical mesh 675 to bonesegments 20, 21, or to attach other objects to bone segments 20, 21.

Looking next at FIGS. 16-18, there is shown a cable retaining washer 712which comprises an alternative form of the invention. Cable retainingwasher 712 is substantially the same as the cable retaining washer 212described above, except that its upwardly projecting extension 755 hasits one or more cable holes 65 extending along an axis substantiallyaligned with the head 25 of screw 9. Again, the upwardly projectingextension 755 may be crimped about a cable loop 15 extending through acable hole 65.

Looking next at FIG. 19, there is shown a cable retaining washer 812which comprises another alternative form of the invention. Cableretaining washer 812 is substantially the same as the cable retainingwasher 712 described above, except that it includes a second upwardlyprojecting extension 755 which also has its one or more cable holes 65substantially aligned with the head 25 of screw 9. Again, the upwardlyprojecting extensions may be crimped about a cable loop 15 extendingthrough a cable hole 65.

Looking next at FIG. 20, there is shown a cable retaining washer 912which comprises another alternative form of the invention. Cableretaining washer 912 is substantially the same as the cable retainingwasher 12 described above, except that its upwardly projecting extension955 has its one or more cable holes extending along an axissubstantially aligned with the head 25 of screw 9. Again, set screw 78may be tightened down so as to secure a cable loop 15 to the cableretaining washer.

Looking next at FIG. 21, there is shown a cable retaining washer 1012which comprises another alternative form of the invention. Cableretaining washer 1012 is substantially the same as the cable retainingwasher 912 described above, except that it includes a second upwardlyprojecting extension 955 which also has its one or more cable holes 65substantially aligned with the head 25 of screw 9. Again, a set screw 78may be tightened down so as to secure a cable loop 15 to the cableretaining washer.

Looking next at FIG. 22, there is shown a cable retaining washer 1112which comprises another alternative form of the invention. Cableretaining washer 1112 is substantially the same as the cable retainingwasher 212 described above, except that the upwardly projectingextension 255 is replaced with a displaced extension 1155 having one ormore cable holes 65 extending therethrough. More particularly, displacedextension 1155 is preferably formed in the same plane as body 45 anddownwardly projecting extension 50, and is displaced both laterally(i.e., along the axis labeled “X” in FIG. 22) and longitudinally (i.e.,along the axis labeled “Y” in FIG. 22) from downwardly projectingextension 50. By displacing extension 1155 laterally and longitudinallyaway from downwardly projecting extension 50, access to the extension1155 with a crimping tool is enhanced.

Looking next at FIG. 23, there is shown a cable retaining washer 1212which comprises another alternative form of the invention. Cableretaining washer 1212 is substantially the same as the cable retainingwasher discussed above, except that it includes a second displacedextension 1155. In one preferred embodiment, the one or more cable holes65 of one displaced extension 1155 are aligned with the one or morecable holes 65 of the other displaced extension 1155. In anotherpreferred embodiment, the two displaced extensions 1155 may bediametrically opposed from one another.

Looking next at FIGS. 24-26, there is shown a suture retaining washer1312 which comprises another alternative form of the invention. Sutureretaining washer 1312 is substantially the same as the suture retainingwasher 612 described above, except that body 645 and upwardly projectingextensions 655 are omitted, and the at least one suture hole 65 isformed directly in the side wall of downwardly projecting extension 650.Preferably at least two suture holes 65 are provided, and the two sutureholes are aligned with one another so as to receive a single suture loop615 therethrough, such as is shown in FIG. 26. Preferably each suturehole 65 has its entrances and rounded somewhat so as to permit thesuture to be slidingly adjusted therethrough prior to fully tighteningdown bone screw 9. However, suture retaining washer 1312 may,optionally, be constructed so that the head of the bone screw will lockthe suture to the washer when the bone screw is fully tightened down.Suture retaining washer 1312 may be secured directly to a bore segment20, 21 if desired, or it may be secured to a bone plate which isdisposed between suture retaining washer 1312 and a bone segment 20, 21.Suture retaining washer 1312 is preferably formed so that it has adiameter substantially the same as the head of a bone screw 9 passingtherethrough, so that the washer can fit beneath the head of the bonescrew and thereby present a minimal peripheral profile.

1-11. (canceled)
 12. A system for securing an object to a bone, saidsystem comprising: a bone screw; a washer comprising: a body; adownwardly projecting extension connected to said body and having ascrew hole extending therethrough for receiving therein the shank ofsaid bone screw deployed in the bone, whereby to secure said downwardlyprojecting extension to said bone, said screw hole defining a firstaxis, with said second axis being aligned with a bone screw extendingthrough the screw hole; and an upwardly projecting extension connectedto said body and having a filament hole extending therethrough, forreceiving a filament therein so as to retain said filament to saidupwardly projecting extension, said filament hole defining a second axisextending substantially perpendicular to said first axis; and a filamentreceived by said filament hole, said filament securing the object tosaid bone.
 13. The system of claim 12 wherein said downwardly projectingextension has a semi-spherical configuration similar to thesemi-spherical underside of the head of the bone screw.
 14. The systemof claim 12 wherein said body forms a recess aligned with said screwhole, said recess receiving the head of the bone screw.
 15. The systemof claim 12 wherein the filament is a suture.
 16. The system of claim 12wherein the filament is a cable.
 17. The system of claim 16 wherein saidupwardly projecting extension is configurable so as to restrain thecable within said filament hole.
 18. The system of claim 17 wherein saidupwardly projecting extension contains a set screw hole communicatingwith said filament hole, and a set screw disposed in said set screw holefor selectively engaging said cable so as to lock said cable relative tosaid upwardly projecting extension.
 19. The system of claim 17 whereinsaid upwardly projecting extension is crimpable.
 20. The system of claim19 wherein said crimpable upwardly projecting extension has atrapezoidal cross-section.
 21. The system of claim 12 further comprisinga second upwardly projecting extension connected to said body and havinga filament hole extending therethrough.
 22. The system of claim 12further comprising a bone plate having a hole extending therethrough,with the shank of said bone screw passing therethrough, and saidfilament retaining washer being secured about the shank of said bonescrew, between said bone and the head of said bone screw.
 23. The systemof claim 15 wherein said suture holds a piece of mesh to the bone.24-29. (canceled)
 30. The system of claim 12 wherein said downwardlyprojecting extension is configured to engage a corresponding recessformed in a bone plate so as to prevent rotation of said filamentretaining washer relative to the bone plate. 31-32. (canceled)
 33. Thesystem of claim 16 wherein said cable is braided cable.
 34. The systemof claim 16 wherein said cable is wire. 35-36. (canceled)
 37. A methodfor securing an object to a bone, said method comprising: providing ascrew, a filament and a suture retaining washer, said suture retainingwasher comprising: a structure having a screw hole extendingtherethrough for receiving therein the shank of the bone screw deployedin the bone, whereby to secure said structure to said bone, said screwhole defining a first axis, and said structure having a filament holeextending therethrough for receiving a filament therein so as to retainsaid filament to said structure, said filament hole defining a secondaxis extending substantially perpendicular to said first axis, with saidsecond axis being aligned with a bone screw extending through the screwhole; securing said washer to the bone with said screw, with saidfilament extending through said filament hole; and using said filamentto secure the object to the bone.
 38. (canceled)
 39. A filamentretaining washer for mounting about the shank of a bone screw deployedin a bone whereby to retain the filament to the bone, said filamentretaining washer comprising: a structure having a screw hole extendingtherethrough for receiving therein the shank of the bone screw deployedin the bone, whereby to secure said structure to said bone, said screwhole defining a first axis, and said structure having a filament hole soas to retain said filament to said structure, said filament holedefining a second axis extending substantially perpendicular to saidfirst axis, with said second axis extending parallel to a third axisextending through said first axis.
 40. A filament retaining washeraccording to claim 39 wherein said screw hole comprises a sphericalrecess about its upper end for receiving therein the underside of thehead of a bone screw whose shank passes through the screw hole. 41-42.(canceled)
 43. A filament retaining washer according to claim 39 whereinsaid filament hole is configured so that a filament extendingtherethrough will be locked to the washer when a bone screw extendingthrough the screw hole is fully tightened down.
 44. A filament retainingwasher according to claim 39 wherein said filament hole is configured sothat a filament extending therethrough will be movable relative to thewasher when a bone screw extending through the screw hole is fullytightened down.